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. 2023 Nov 22:28:100634.
doi: 10.1016/j.lana.2023.100634. eCollection 2023 Dec.

Effect of the Mamás del Río programme on essential newborn care: a three-year before-and-after outcome evaluation of a community-based, maternal and neonatal health intervention in the Peruvian Amazon

Magaly M Blas  1 , Stefan Reinders  1   2 , Angela Alva  1 , Melissa Neuman  2   3 , Isabelle Lange  2 , Luis Huicho  4 , Carine Ronsmans  2
Affiliations

Effect of the Mamás del Río programme on essential newborn care: a three-year before-and-after outcome evaluation of a community-based, maternal and neonatal health intervention in the Peruvian Amazon

Magaly M Blas et al. Lancet Reg Health Am. .

Abstract

Background: Despite remarkable progress in maternal and neonatal health, regional inequalities persist in Peru. In rural areas of Amazonian Loreto, access to quality care is difficult, home births are frequent, and neonatal mortality is high. We conducted a prospective before-and-after study to assess the effect after implementation and over time of a community-based intervention on essential newborn care (ENC).

Methods: Mamás del Río consists of tablet-enhanced educational home visits by Community health workers (CHW) to pregnant women and mothers of newborns, with supportive training on ENC of traditional birth attendants and facility staff. The study area comprised 79 rural communities of three districts in Loreto. Primary outcomes were ENC practices in home births, secondary outcomes were ENC in facility births as well as healthcare seeking, measured at baseline before and at year 2 and year 3 after intervention implementation. Community censuses included questionnaires to women aged 15-49 years with a live birth. We calculated prevalence of outcomes at each time point and estimated adjusted prevalence differences (PD) between time points using post-estimation based on logistic regression.

Findings: Following implementation early 2019, 97% of communities had a trained CHW. At year 2 follow-up, 63% (322/530) of women received a CHW visit during pregnancy. Seven out of nine ENC indicators among home births improved, with largest adjusted prevalence differences in immediate skin-to-skin contact (50% [95% CI: 42-58], p < 0.0001), colostrum feeding (45% [35-54], p < 0.0001), and cord care (19% [10-28], p = 0.0001). Improvements were maintained at year 3, except for cord care. At year 2, among facility births only three ENC indicators improved, while more women gave birth in a facility. Sensitivity analyses showed ENC prevalence was similar before compared to after onset of Covid-19 lockdown.

Interpretation: ENC practices in home births improved consistently and changes were sustained over time, despite the onset of the Covid-19 pandemic. A community-based approach for behaviour-change in home-based newborn care appears effective. Process evaluation of mechanisms will help to explain observed effects and understand transferability of findings.

Funding: Grand Challenges Canada and Peruvian National Council of Science and Technology.

Keywords: Amazon; Community-based intervention; Essential newborn care; Evaluation; Indigenous; Maternal-neonatal health; Peru.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Mamás del Río study area (own assembly, reproduced from Reinders et al., 2020).
Fig. 2
Fig. 2
Conceptual framework of the Mamás del Río intervention.
Fig. 3
Fig. 3
Implementation of intervention and evaluation activities throughout the study period. Numbers denote separate implementation activities. Baseline CHW training (1) was implemented between December 18 and February 19; repeat trainings to replace dropouts (2, 3, and 4) were implemented thereafter. Intervention kicked-off with start of supervision activities in Feb ‘19 and terminated with last supervision in October 21; for a total duration of 2 years and 8 months. The first census for baseline measurement was conducted between December 18 and January 19, with a 1-year recall period and earliest birth included was in December 17. The second census for follow-up was planned one year after but postponed to November 20 due to Covid-19 with an extended recall period. The third and last follow-up census conducted in November 21 with a regular 1-year recall period.
Fig. 4
Fig. 4
Coverage of CHWhome visits and retainment of active CHW over time. Annotations: Data of CHW visits based on women questionnaire. Data on CHW retainment based on supervisor documentation. Total number of dropouts: 2019 (n = 17), 2020 (n = 5), and 2021 (n = 7); Number of dropouts from the initial cohort: 2019 (n = 14), 2020 (n = 2), and 2021 (n = 5).
Fig. 5
Fig. 5
a–c: Primary outcomes:thermal care, breastfeeding practices, and cord care reported by women between 15 and 49 years who had a live birth at home—at baseline, follow-up year 2, and follow-up year 3.
See this image and copyright information in PMC

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